BOOSTER SHOTS: Oddities, musings and news from the health world

Reporting from New Delhi — Under threat from cigarette manufacturers, the Indian government has deferred the use of new, pictorial warnings on cigarette packs by a year. The new warnings, part of India's anti-smoking effort, were to be implemented on Dec. 1 after earlier delays in March.

The delay came a week after two of India's largest cigarette makers halted production citing a "lack of clarity" on pictorial warnings. Activists saw the production stoppage as a pressure tactic and claimed the companies had produced "excessively in the past six months and may have shut for maintenance work."

Public health activists were unhappy with the government's order and said they believed it was taken under tremendous pressure from cigarette manufacturers. They "have made the government do what was beneficial to them and have made the government sidestep the issue of public health," said Bhavna Mukhopadhyay, executive director of the Voluntary Health Assn. of India.

The move has public health advocates concerned. The recently released Global Adult Tobacco Survey of India 2010 showed that pictorial warnings have a positive effect on reducing consumption. The survey found that nearly a third of tobacco users considered quitting because of the warnings, which feature a lung and a scorpion symbol with a health message. Some "5,500 young people are initiated into cigarette smoking every day," Mukhopadhyay said. "Most of our population is illiterate and can't read warnings. Pictorial warnings are the most cost-effective and impactful way of warning these people."

Even as the government apparently backed down under pressure, the country's highest court has banned plastic packaging for tobacco products. In a reference to the fight against cancer, the court said that unlike government, it could not remain a mute spectator to the public health menace and asked the government to implement the order by March, even if it "brings the entire tobacco industry to a standstill."

Two related products linked to cancer made from beetle nut -- gutka and pan masala -- are sold in small plastic pouches often priced at less than 5 cents and are very popular in India. The plastic pouches clog sewage lines and are seen as a health hazard, presumably because it backs up waste water.

India is the world's second-largest producer and consumer of tobacco products behind China, according to the American Cancer Society and the World Lung Foundation. An estimated 241 million people in India use tobacco in some form and about 1 million die from tobacco use annually.

The court also ordered the government to establish an independent agency to test the contents of the beetle nut products to evaluate the risk to consumers. Health activists said they were heartened by the court action and said the government would likely have a difficult time explaining to the judge why it delayed pictorial warnings a second time.